muchmorewherethatcamefrom

Medicine vs. Motherhood vs. Martyrdom

In Medicine, Peanut, Tolkien on June 22, 2011 at 4:53 pm

It almost feels like a cliche for me to jump into the fray surrounding this recent New York Times op-ed by one Dr. Karen Sibert.  If you haven’t heard about it, Dr. Sibert is a physician who claims that the problem with American medicine today is female physicians who work part-time.  Practicing medicine is a privilege, she says, and to be worthy of that privilege, women need to put their medical careers first.  She is a full-time physician and a mother of four who “never took cupcakes to [her] children’s homerooms” because she had her priorities in order.

OK.  I am a doctor.  I am a mother.  And I work part-time.  As someone who is apparently part of the downfall of Western medicine, allow me my rebuttal.

I agree with Dr. Sibert that practicing medicine is a privilege.  Despite all my years of work, stress and self-denial, I still remember plenty of pre-meds who would have killed for a med school acceptance and never got any.  So in that sense, an MD is something to be thankful for and to live up to.  On a visceral level, too, it is a true honour to have someone consent to be your patient; to have people put their trust and their health in your hands.  I feel the weight of that honour and responsibility every day.  I went into medicine to help people (like almost every physician I’ve ever known) and it’s a gift to know that your job is doing some good in the world.

That being said, however, going into medicine requires a tremendous level of sacrifice of which the public is often not aware.  I would venture to say that most people going into it are also not aware — till they’re in it.  The years alone are a burden: becoming a doctor entails 4 years of college, 4 years of med school, 3-7 years of residency, and 1-5 semi-optional years of fellowship.  Then there is the financial cost: for those first 8 years, you are accruing a frightening amount of debt (for some, close to $300,000) even if you are fortunate enough to go to in-state schools and receive scholarships.  For residency and fellowship, you are making just enough to live on and usually not enough to start paying down your debt.  That means that by the time you are in your mid-30s, interest has been added to your principal at an alarming rate.

Then there is the level of personal sacrifice.  The hundreds of big and little family events that you will miss because you are studying or on call; the numerous “firsts” of your children that your spouse or nanny tells you about because you weren’t there; the times your loved ones needed you and you were forced to let them down.  A colleague in my own residency program was told that she could not accompany her husband to surgery because she was expected at work.  Tolkien himself was the best man at his brother’s wedding last month and could not get a single day off; the only way he could attend was to take call the night before (which, thanks to recent resident work-hour laws, now entitles you to go home the next day) which meant that he had to travel and participate in the wedding on no sleep, had to miss the rehearsal dinner, and of course had to miss the Caribbean cruise the entire wedding party except us took afterwards.  I know the toddlers of several friends who believe they live at home and their mommy or daddy lives at the hospital.  I distinctly remember going to pick up some groceries post-call one day as an exhausted intern, looking around at the smiling, well-rested customers in the store, and resenting them for leading what seemed to me to be a normal, unattainable life.

The price you pay with your own mental and physical health is another given.  It depends on your specialty and your program, but in general residents live on far too little sleep for years.  A couple of nights a week they take overnight call, which means they work 30 hours straight, and several times a year they work the night shift for weeks at a time.  The stress level is through the roof when you are dealing with life-or-death issues, heavy caseloads, rude or violent patients and/or unreasonable residency supervisors.  Eating on the run, if at all, is the norm.

So after all these years of delayed gratification (a popular catchphrase in medicine) I think it is only reasonable for physicians to feel that they finally deserve a more tolerable lifestyle.  Medical training is only doable because there is a light at the end of the tunnel.  I can tell you that if I thought my whole working life was going to be like med school and residency, I would have left medicine completely — and I actually had really good experiences in med school and residency!  But the unfortunate truth is that practicing medicine as a fully-trained physician is still a very stressful, time-consuming endeavour; the hours might be slightly better than residency, and the pay usually is better, but you shoulder the added burden of high legal risk in a society where doctors can and will be sued for things over which they have absolutely no control.  In order to survive and continue to provide a service to at least some patients, I don’t blame physicians at all who feel they need to go part-time to preserve their sanity.

Then there’s the whole parenthood thing.  Women in medicine, because of our biological clocks, often have no choice but to start having children before their training is over, because most physicians are well into their 30s by the time they’re done.  Dr. Sibert claims that we owe it to our patients to take full-time care of them.  So what do we owe our children?  They don’t deserve as much as we give our patients?  I would argue that if what she says is correct, and part-time physicians don’t deserve to be physicians, then full-time physicians don’t deserve to be parents.  I’d love to hear if she thinks that’s fair.  (I’d also love to hear how happy her own four children were with her parenting.)

Dr. Sibert’s argument that physicians should ALWAYS be taking care of their patients can also be carried much farther than she takes it.  Has she ever taken a weekend off?  Does she plan to retire one day?  How dare she?  Additionally, I thought it was a total contradiction in terms that she said she never drove her kids’ carpools, but she attended their soccer games and plays.  What does that even mean?  How was she caring for her patients while she was doing those things?  She says, “If you want to be a doctor, be a doctor.”  Then why was she ever taking a break to be a parent?

I’m sure my fellow docs will agree with me on my next point, which is that, hello, this woman is an anesthesiologist.  It’s all well and good to claim you care more about your patients than someone who works part-time, but let’s be real here: YOUR PATIENTS ARE ASLEEP.  If you cared so much more than everyone else in medicine, why aren’t you an underpaid, overworked primary care physician (who are the real heroes of medicine, in my opinion)?  As many of you know, Tolkien is in anesthesiology, so I’m speaking with some inside knowledge here.  I have the utmost respect for anesthesiologists — they provide essential medical services.  They are absolutely highly skilled and indispensable.  It’s just that it’s totally disingenuous not to tell the public that the reason why a lot of people go into anesthesiology is so that they don’t have to deal with mean patients.  I’m glad anesthesiologists do what they do; just don’t pretend that other physicians don’t have very different challenges.

I’ve seen a lot of different comments on this op-ed around the Internet, and one thing someone said was that what this woman wants is for doctors to live inhuman lives to accommodate a broken system, rather than fixing the system itself.  The op-ed raises a good point about the government not being able to capitalize as well on its investment when doctors go part-time.  I don’t pretend to know the solutions, but I suspect there must be at least a slightly better way, given that many other developed countries have excellent medical systems without their physicians leading brutal lives.  I remember speaking to a surgeon who trained in India and had practiced in the U.S. for 25 years.  “I worked only 12-hour shifts as a resident,” he told me, “and the truth is that I am just as adept a surgeon as anyone else here.”  I’m sure there will be people who argue that he was fooling himself, but the fact remains that many, many people who were trained elsewhere have expressed the same sentiment.  They can’t all be crazy.  The argument in the U.S. is that long work hours allow for many more patients and cases to be seen over the course of a residency, but there’s a lot to be said for the effects of sleep and decreased stress on the retention of learning and knowledge.  And that philosophy of a work-life balance would probably improve things if carried over to the rest of a physician’s career.  People go into medicine because they want to help people.  They could have chosen much easier ways to make a living.  So why would we want to beat that caring out of them?

And if Dr. Sibert is so convinced that part-timers are sending medicine to hell in a handbasket, why is she targeting only women?  What about men who go part-time?  It’s amazing to me that in this day and age, the biggest opponents of women are often other women.  Wasn’t the women’s lib movement about the freedom to choose your own life?  I’m not sure how it’s progress to go from being forced to be a housewife to being forced to work full-time outside the home.  I understand that she feels it’s OK to work part-time in any other field but medicine, that medicine is different.  All I have to say to that is that if you want the best and brightest to go into medicine (and let me tell you, I DO; there’s nothing more dangerous than a dumb doctor) then you better make it somewhat appealing.  If you’re a good student who sees that medicine involves heavy debt, legal risk, poor health, never seeing your loved ones and slaving for long hours for the rest of your life, wouldn’t investment banking start seeming like the smarter option?

Really, though, this woman was looking for a fight.  There’s no way she could have written this in the New York-freaking-Times without knowing she was inciting the ire of thousands.  As my good friend Ollie noted, it makes you wonder what kind of practice she works in.  I’d guess it’s one with several female part-timers whom Dr. Sibert resents, with the leadership comprised fully of male full-timers on whose good side Dr. Sibert wants to get.  The national punishment must be worth her local reward.

Well, good luck to you, Dr. Sibert.  It’s no surprise that I would bristle at her article, but all she did was convince me that I am doing the right thing (for us; I fully support any other parent who believes that working full-time is the right thing for them.)  In a lot of ways I’m a single parent while Tolkien is in residency, and taking care of Peanut and the house and the rest of our lives would be utterly impossible if we were both working crazy hours.  I cherish the fact that I can spend the little moments with Peanut on a regular basis and that I’ll be able to look back on this short baby/toddler stage knowing that I didn’t have to miss it.  I am eternally grateful for the fact that I am able to work part-time and maintain my medical license and skills while still being there for my child at least some of the time.  I really believe that patients are better served by a happy, less-stressed physician.  (Peanut’s pediatrician is a part-timer and I can tell the difference in her entire demeanor.  And I myself spend a lot more time on careful documentation and looking up things for my patients simply because I have more time.  Of course, that’s working time for which I’m not paid, but that’s just a fact of life in the world of part-time work.)  And I really like the comment of one Susan K. Burden who commented on Dr. Sibert’s article: “The degree is a doctorate in medicine, not an application for martyrdom.”  Hallelujah, sister.  Working hard benefits everyone; working yourself to death benefits no one.

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  1. Dear Much,
    Great blog! I respect you for courageously and thoughtfully offering an opposing argument to Dr. Sibert’s article. People of good conscience are compelled to respond when they read articles that so clearly have another perspective!

    I also agree with Susan K. Burden’s comments…so very true!

    Peanut will only be a baby once in her life…you’re absolutely doing the right thing!

    Thank-you,
    Leenamerene

    • Thank you Leena! I don’t kid myself — I still do miss things with Peanut. I’m not with her full-time. But I think realistically, within the confines of our actual situation and not what we wish it might be, this is the best solution. Thanks for your support! And congratulations again — we’re so proud of you!

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